DEFINITION : Chickenpox is an infectious disease caused by the varicella zoster virus (VZV), a virus that is part of the herpes virus family.
PREVALENCE OF DISEASE Very common in the U.S before the vaccine became available in 1995. • In early 1990s, an average of 4 million people got chickenpox. • 10,500 -13,000 were hospitalized. • 100 - 150 died each year . Each more than 3.5 million cases of varicella, 9,000 hospitalizations, and 100 deaths are prevented by varicella vaccination in the United States . Studies show that from 1995 to 2005, the occurrence of this disease has decreased by 90% among children and adolescents
EPIDEMIOLOGICAL FACTORS The source of infection-person infected by chicken pox. Commonly found in winter season Occurs more in children than in adults . One attack of disease produce sufficient resistance power for long period. Transmission of disease- mostly through personal contact or droplet infection.
INCUBATION PERIOD INCUBATION PERIOD 7-21 days CAUSATIVE ORGANISM: Varicella zoster virus also called human (alpha) herpes virus.
PATHOPHYSIOLOGY Infection of conjunctiva or upper respiratory tract Replication of the virus in regional lymph nodes Viremia Viral replication in liver , spleen , and other organs Secondary viremia Appearance of varicella rash Crusting of vesicles (1-2 weeks)
SIGN AND SYMPTOMS In children: Itchy rash appears on the head and spreads down to the trunk and other body parts. The rash becomes raised, and blisters form. Blisters may also form on mucous membranes, such as inside the mouth, nose, throat, and vagina . The blisters crust over and disappear within about 10-14 days. Children may also have fever and tiredness along with the rash.
In adults: In adults: • Pre-eruptive stage: At the onset of disease, low or moderate fever , feeling cold, restlessness, backache etc. are complained . • Eruptive phase: After the pre eruptive phase the rashes are found on the body which are less on face and hands and more on the body . . Different stages of rashes are (macular ,papular ,vesicular ) found together. This is the special characteristic of the disease . • The eruptive stage last for 4-7 days
macular RASH
papular RASH
vesicular RASH
SIGNS AND SYMPTOMS SERIOUS SYMPTOMS High fever Vomiting Diarrhea Headache Dehydration Worsening of asthma
SIGNS AND SYMPTOMS Chicken Pox & The Immune System The virus 1st infects the mucous of the upper respiratory tract Viral proliferation occurs in lymph nodes for 2-4 days after initial infection 4-6 days after initial infection, virus enters blood stream This is followed by a second round of replication in body’s organs Especially in Spleen & Liver
COMPLICATIONS COMPLICATIONS Pneumonia Bleeding Encephalitis Serious diseases of fetus in case of pregnancy.
DIAGNOSTIC EVALUATION DIAGNOSTIC EVALUATION: • Sign and symptoms, the typical spread of rashes and the appearance of different stages of rashes together are helpful in making diagnosis
VACCINES FOR CHICKEN POX VACCINES FOR CHICKEN POX The chickenpox vaccine is live attenuated vaccine and not recommended for people with weak immune system The chickenpox vaccine was added to the childhood immunization schedule in 1995. The booster dose was added in 2006.
VACCINES FOR CHICKEN POX The U.S. Advisory Committee on Immunization Practices recommends 2 doses of the vaccine for children. The 1st dose is given around at 1 yr. and the 2nd around age 4-6 yrs. A single dose of the vaccine reduces risk up to 70-90%, and 2 doses reduce the risk even more.
VACCINES FOR CHICKEN POX • It is available as a single vaccine, also as part of the MMRV vaccine (measles, mumps, rubella, and varicella vaccine). Route : Subcutaneously When chickenpox occurs in vaccinated individuals, these cases are known as “breakthrough cases ”. These cases are usually very mild compared with the disease in unvaccinated individuals.
MEDICAL MANAGEMENT Care for chickenpox usually includes use of pain medications and topical treatments for the itchy rash, blisters, and scabs . In serious cases, anti-viral drugs can alter the course of the illness. These are typically given early to people at highest risk of complications, including sick children and pregnant women.
NURSING MANAGEMENT Prevent infection: - Prevent the spread of the disease Wear gloves to perform dressing Change the bed linens frequently Wear a mask or have the patient wear a mask
NURSING MANAGEMENT Treat itching: - Cut the patient’s fingernails short Encourage frequent hand washing. Use of antihistamines or soothing skin lotions such as calamine to ease the itching. Use of baking soda in a cool bath may also decrease itching.
NURSING MANAGEMENT Other treatment: Assess the patient frequently to manage symptoms such as itching or to detect symptoms that may indicate a complication, such as a moist cough that could signal early pneumonia.
DIETERY MANAGEMENT Foods which are easily digestible like plain rice and dal are advised. Non vegetarian diet strictly avoided. The diet mostly consist of fluids like fruit juice, coconut water, vegetable soup etc. Fluid diet helps the nutrients to be absorbed faster .
DIETERY MANAGEMENT Include Zinc, magnesium and calcium supplements in diet to enhance the immune system. Enhanced immune system help in quick cure.
DIETERY MANAGEMENT Encourage fluids and a healthy diet. Some patients develop sores inside the mouth and may need soft foods that are easy to chew and swallow. Chicken Pox diet should include coriander and carrot soup once every day
SUMMARY Chicken pox is an infectious disease caused by the varicella virus. Most cases develop in children under age 15 but older children and adults can get it. It spreads very easily from one person to another. Symptoms of chickenpox include an uncomfortable, itchy rash, fever and headache.
SUMMARY The disease is usually mild and lasts 5 to 10 days, but it sometimes causes serious problems. Adults and older children tend to get sicker from chickenpox. Do not give aspirin to anyone sick with chickenpox since the combination might cause Reye’s syndrome